When a doctor’s right to choose trumps a woman’s right to choose

On the books, abortion in Italy is legal. In practice, it is out of reach for many women.

An unprecedented wave of so-called conscientious objectors — doctors declining to perform abortions for personal or religious reasons — is sweeping the country. Today, 70 percent of Italian gynecologists and 48.4 percent of anesthesiologists decline to perform terminations, according to a report from the Italian health ministry presented in December.

In more conservative regions such as Sicily and Campania, as much as 84 percent of doctors object to abortion. That leaves a tiny group of abortion providers to deal with a huge demand for terminations.

Health ministry figures show that the proportion of doctors who are conscientious objectors rose 12 percent in the last decade, while abortions dropped from nearly 140,000 in 2004 to 88,000 in 2015. Some 59.7 percent of Italian hospitals perform abortions.

In the southern region of Molise, there is just one doctor, Michele Mariano, left to perform up to 400 abortions a year on his own.

Abortion has been legal, and covered by national health plans, for nearly 40 years in Italy. When approved back in 1978, the law known as “la 194” was considered progressive. Christian Democracy, one of the leading parties at the time, inserted a clause allowing doctors to declare themselves conscientious objectors by simply submitting a formal request to the health ministry.

So while on paper, Italian women are allowed to get an abortion within 90 days of pregnancy, in practice many struggle to find a doctor who agrees to perform the procedure.

“Since February 2009, when the region struck an agreement with Catholic hospitals, I am the only one left here,” Mariano said from his outpost in Molise, the only center giving abortions in the region. Since he started to work there many of his colleagues have begun to avoid him and he’s been passed over for promotions, he said. “In Italy, we have the Vatican. If you want to have a career as a doctor you have to be a conscientious objector.”

In 2015, the number of “voluntary interruptions of pregnancies,” as abortions are called, fell to less than 100,000 for the first time since the procedure was legalized, according to data from the national ministry of health.

“Today the law is absolutely outdated, but the current parliament refuses to update it,” said Mario Puiatti, the president of the Italian Association for Demographic Education, which provides outpatient women’s health services. “Unfortunately, every hospital department chief in Italy is a conscientious objector, which is as if one in three police officers refused to use their gun.”

“If you want to get an abortion in Sicily, the best way to get it is to jump on a plane,” he added.

Italy has among the lowest birth rates across the EU, with an average of 1.4 children born for every woman of childbearing age, compared to the EU average of 1.55, according to the latest figures published by Eurostat. The number of abortions relative to the population across Europe has been dropping over time.

Poland’s conservative government recently attempted to pass a law that would have banned all abortions unless a mother’s life was at risk. Women took to the streets in protest | Wojtek Radwanski/AFP via Getty Images

Last autumn, Italy’s health minister Beatrice Lorenzin launched a fertility campaign that was highly criticized on social media for bluntly warning women their biological clocks were ticking. To defend the campaign, Lorenzin, a politician from the New Center Right party, said Italy and Europe had “a serious birth rate issue.”

“Even the World Health Organization’s regional office for Europe has included in its objectives lately to create information and education campaigns about the fertility of the European population,” she added.

The WHO said their EU office “has not organized any information and education campaigns about the fertility of the European population.”

Anti-abortion laws sweep Europe

Abortion providers are under pressure across the Continent.

Terminating pregnancy remains illegal in Malta and Ireland, and lawmakers are attempting to restrict the option further in other countries. Poland’s conservative government recently attempted to pass a law that would have banned all abortions unless a mother’s life was at risk and could have imposed prison sentences on doctors and on women seeking abortions. In November, the Polish parliament passed a law to pay women whose babies are born with severe and possibly lethal developmental problems.

“In Poland, however, the choice [of abortion] is only theoretical,” journalist Agnieszka Wiśniewska wrote in Krytyka Polityczna, a left-leaning magazine, at the time. “The new law is in fact preparing ground for another attempt to tighten abortion law in Poland.”

Croatia introduced a law in 2003 to allow medical professionals to exercise their right of conscientious objection. The abortion rate has dropped dramatically over the past few decades.

Italy’s situation is unique. No new laws are in the pipeline that would constrict the rights of women. Legally, nothing has changed at all since “la 194.”

But on the ground, procuring an abortion has undoubtedly become more difficult. In October, 32-year-old Valentina Miluzzo died following complications during her 19th week of pregnancy with twins. The doctor in the hospital where she was treated allegedly refused to terminate her pregnancy even though it had put her life at risk. Italian prosecutors are investigating her death. Twelve doctors working at the hospital where the woman died are currently under investigation, according to Italian daily La Repubblica.

The rise among Italian doctors of conscientious objectors does not constitute a problem, according to Giuseppe Noia, president of the Association of Italian Catholic Gynecologists and Obstetricians. “The rise corresponds to a rise of awareness among the medical personnel,” he said. “Conscientious objection was abolished under the Nazis. Do we want to return to those dark days?”

To discourage the practice, the health ministry recently increased the fine for women getting illegal procedures from €5,000 to €10,000.

Lorenzin says the situation is under control. The number of hospitals performing abortions may be declining, but the numbers remain more than satisfactory, the minister wrote in the December report.

“Although in some Italian regions the percentage of conscientious objection is high, by analyzing the average weekly working load of gynecologists not objectors, we assessed that there is no critical situation,” said Serena Battilomo, director of the prevention office at the ministry.

Alternate abortion

Difficulty terminating pregnancies in Italy is leading women to have clandestine abortions, according to LAIGA, the Italian association of doctors who are not conscientious objectors. Silvia Agatone, a 62-year-old gynecologist, founded the association in 2008 to provide women with information on where they could get an abortion.

“The fact that women are denied access to legal abortion results in them seeking a solution illegally” in unlicensed clinics in often dangerous conditions, she said. “We are starting to see women coming to public hospitals with incomplete terminations, and we have also seen that the number of ‘spontaneous abortion’ carried out in private clinics is rising.” She added that her association asked the ministry to do a study on clandestine abortion, but authorities refused to do so.

Agatone called into question the health ministry’s data, arguing the government only measures the number of abortion carried out, not the number of abortions requested.

To discourage the practice, the health ministry recently increased the fine for women getting illegal procedures from €5,000 to €10,000. LAIGA condemned the measure as punishment for women, instead of doctors who refuse to fulfill their medical obligations.

The association has campaigned against deteriorating access to abortion in Italy for the last decade. In 2014, it filed an international appeal to the Council of Europe, which ensures states uphold the European Convention on Human Rights. The Council ruled against Italy, stating that weak regulation regarding conscientious objectors violated women’s right to receive health care services guaranteed by Italian law.

In a more recent ruling responding to a complaint from the General Confederation of Labour (CGIL) — the country’s largest trade union — the Council of Europe’s social rights committee charged Italy with discriminating against women for the difficulties they face finding a willing doctor and the alleged discrimination abortionists face from their fellow doctors.

According to the committee, doctors willing to perform abortion face “direct and indirect labor disadvantages.”

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wi

it is not that easy for some doctors to kill babies. it is always a terrible crime against God’s loving and innocent creature.

Posted on 2/9/17 | 10:00 AM CET

Nat

frightening descend…and an opportunity for simpletons to yap about killing babies, Gods and flying saucers…

Posted on 2/9/17 | 12:21 PM CET

TAK

At first rich Europeans kill millions of own children because they would like to have easy and fun life without any responsibilities.
Then they have understood that somebody has to serve them food in restaurants, drive their taxies and clean streets.
So they invited millions of young emigrants with different culture and religion background.
It’s how civilizations make suicide…

Posted on 2/9/17 | 3:23 PM CET

Jakob Cornides

Astonishing that this is even an issue rfor POLITICO, a newspaper that should set its focus rather on European politics than on promoting radical agendas such as a “right to choose killing children”.

Anyway, the issue raises a more general point: why and to what extent should someone be forced to act in a manner that is contrary to what his conscience commands him – in particular when that action would involve killing someone?

There is a difference between being obliged to tolerate something one doesn’t like, or being obliged to oneself do something one objects to.

If on an island like Sicily, with more than 5 million inhabitants, it is not possible (as your article suggests) to find a doctor willing to perform abortions, then that sentiment appears to be fairly widespread among the medical profession. Apparently, this is not a “lunatic fringe” of “bigots” or “ultra-conservatives”, but the mainstream of medical professionalists. If that is so, their attitude can hardly be considered unreasonable, or bigot, or whatever. It simply shows awareness that abortion, whatever the circumstances may be, means to deliberately kill a human being.

Posted on 2/9/17 | 4:28 PM CET

Linda Hunter

Men and religious people need to get out of women’s health care. They don’t know nothing about birthen no babies . Women dying in child birth proves it.

Posted on 2/9/17 | 8:59 PM CET

Sept of Baelor truther

@wi
Which god? The tyrant from the bible who had no problem (if the story is to be believed) with drowning just about everyone?

Posted on 2/9/17 | 9:46 PM CET

Gavin Crowley

The tide is going out for the legal abortion experiment.

Posted on 2/10/17 | 4:03 AM CET

fatbob

@Linda

I’m sure that many of the doctors who refuse to do this are women.

And many of the doctors who don’t are men.

Life is just not as simple as you appear to think it should be.

The 2 areas that involve the ending of human life – abortion and euthanasia – should allow those expected to perform the procedures to refuse on the basis of conscience. There are plenty of medical professionals who do not have an issue with either.

Posted on 2/10/17 | 10:14 AM CET

Josef Papug

Please, do not connect fertility rate with abortions. There is no statistical data, to support that connection throughout the world.
Also, repressive abortion law does not lower abortion numbers. The lowest abortion stats are in the countries, where unrestricted abortion is allowed for dozens of years – eg. Germany and Scandinavia. The highest abortion rates (legal and illegal) are in the countries with very strict laws like eg. Poland.

Posted on 2/12/17 | 10:40 AM CET

Mary

those lucky kids that won’t be aborted. good for themm

Posted on 2/12/17 | 10:26 PM CET

Roman

Poland’s been like that for decades. Rich women can have a private abortion, poor women stuff dead babies in bins.

Posted on 2/13/17 | 10:35 AM CET

Maria

@ TAK

You are one of the persons whose views are not influenced by facts. a it happens, the countries in which it is more difficult to get an abortion (Italy, Poland, Malta – rad: Catholic countries) happen to be the ones with the lowest birth rate.

Phoetus is not a baby, by the way.

Also as it happens, the best way to lower number of abortion is to polarize sex ed and contraception. Funnily enough, people who claim t be most opposed to abortion oppose also those two.